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_,. Waste Tire Su_vey & Inspection Repok SURVEY REQUIRED <br /> ® �G State of California <br /> CIWMB193 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection IReport <br /> Site Suffix: 3 , 7 9 7 �i �_✓ Number: I I 6 ` — ; 1 �� <br /> � <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> eco,rrtz� %�•..�ccG�i�� ��: C' f V /.3 <br /> - . <br /> Els/ted <br /> 42408 <br /> Elx sial p �. E I2 3 <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy.LEA <br />